Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | PA00001 | TX |
NPI | 1073523841 |
---|---|
Provider Name | Dwight M Deter |
First Address | El Paso, TX 79902-4672 |
Second Address | El Paso, TX 79902-4672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P80361 | (02) | TX |